The Relationship Between Anxiety and Suicidal Ideation in Patients With Bipolar Disorder: Chain Mediation Effects of Social Support and Self-Esteem

Abstract

Background: Bipolar disorder is associated with a high prevalence of suicidal ideation, and comorbid anxiety may further increase suicide risk. The psychological mechanisms linking anxiety to suicidal ideation, especially the roles of social support and self-esteem, remain unclear. This study constructed a chain mediation model to examine how anxiety, social support and self-esteem relate to suicidal ideation in patients with bipolar disorder.

Methods: From March 2022 to May 2023, 450 inpatients with bipolar disorder were recruited from six hospitals in Anhui Province. Standardised scales assessed anxiety, social support, self-esteem and suicidal ideation. Pearson correlation examined associations between variables, binary logistic regression identified factors associated with suicidal ideation, and Hayes' PROCESS macro tested the chain mediation model.

Results: Logistic regression showed that higher anxiety increased the odds of suicidal ideation, whereas higher social support and self-esteem reduced the odds. Suicidal ideation was positively correlated with anxiety and negatively correlated with social support and self-esteem, and mediation analysis demonstrated a significant direct effect of anxiety and significant independent and chain mediating effects of social support and self-esteem (all p < 0.001).

Conclusions: Anxiety is related to suicidal ideation in patients with bipolar disorder both directly and indirectly through reduced social support and self-esteem. The indirect pathway via self-esteem showed the largest effect, underscoring the need to enhance social support and self-esteem in suicide prevention for this population.